Active NPI
Kathryn Elise Quintanilla, PA-C
- Physician Assistant
- Fort Worth, TX
National Provider Identifier
1104526862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA16705
- Practice address
- 4927 Byers Avenue
Fort Worth, TX 76107 - Phone
- (817) 994-2655
- NPI assigned
- Mar 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA16705 | TX | Primary |
Addresses
Primary practice location
4927 Byers Avenue
Fort Worth, TX 76107
Mailing address
4927 Byers Avenue
Fort Worth, TX 76107
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 9, 2026 through Jan 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA16705 | TX | MD | Physician Assistant |
Interoperability endpoints
- kate.quintanilla@619564049235972.direct.elationemr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682467200000",
"number": "1104526862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4927 BYERS AVENUE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4927 BYERS AVENUE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "76107",
"telephone_number": "817-994-2655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUINTANILLA",
"first_name": "KATHRYN",
"middle_name": "ELISE",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-09",
"last_updated": "2023-04-26",
"certification_date": "2023-04-26",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA16705",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.